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1.
J Nurs Educ ; 61(1): 36-40, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35025674

RESUMEN

BACKGROUND: Numerous studies have revealed that nursing students perceive lack of confidence as one of the key barriers to performing physical examination; however, it is not empirically measured. This study aimed to test the psychometric properties of the Physical Examination Perceived Self-Efficacy Instrument. METHOD: The study included three phases: in Phase 1, 51 items were constructed; in Phase 2, 7 field experts rated items for relevancy; and in Phase 3, the instrument was piloted to a convenience sample of 238 students. RESULTS: The analysis yielded six factors with a factor loading >0.40. The corrected item-total correlation ranged from 0.6 to 0.87. Cronbach's alpha ranged from .84 to .98. The interscale correlation of the instrument was statistically significant (p < .001). CONCLUSION: We found that the instrument is a psychometrically robust measure of self-efficacy of performing physical examination. The instrument could provide a better understanding of the association between perceived self-efficacy and students' academic performance. [J Nurs Educ. 2022;61(1):36-40.].


Asunto(s)
Bachillerato en Enfermería , Estudiantes de Enfermería , Humanos , Examen Físico , Psicometría , Reproducibilidad de los Resultados , Autoeficacia , Encuestas y Cuestionarios
2.
Fam Process ; 2022 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-35040124

RESUMEN

Since 2006, the U.S. Administration for Children and Families (ACF) has allocated $1.2 billion to a Healthy Marriage and Relationship Education (HMRE) policy initiative that provides grants to community organizations to support relationship education (RE) services for lower income couples and individuals. The policy aim was to help disadvantaged couples and individuals form and sustain healthy, stable relationships and marriages. A significant body of research on the effectiveness of these programs has now accumulated. This meta-analytic study reviews all evaluation research reports of adult couple relationship education (CRE) programs supported by the ACF policy initiative to examine their impact on an array of couple, family, and individual well-being outcomes. Overall, our review of 32 control-group studies found a range of small but significant effects for couple relationship quality (d = .114), relationship skills (d = .132), mental health (d = .074), and coparenting (d = .033), but non-significant effects for relationship stability, parenting, and child well-being. Supplemental analyses with 19 1-group/pre-post studies showed larger effects. Planned moderator analyses explored significant heterogeneity in most effects, however, revealing interesting implications for practice and research going forward.


Desde 2006, la Administración para los Niños y las Familias (Administration for Children and Families, ACF) de los Estados Unidos ha destinado $1.2 mil millones a una iniciativa de una política de Capacitación en Relaciones y Matrimonios Saludables (Healthy Marriage and Relationship Education, HMRE) que ofrece subvenciones a organizaciones comunitarias con el objetivo de financiar servicios de capacitación en relaciones para parejas y personas de bajos recursos. El objetivo de la política es ayudar a las parejas y a las personas desfavorecidas a formar y mantener relaciones y matrimonios estables y saludables. Actualmente se ha acumulado un número considerable de investigaciones sobre la eficacia de estos programas. En este estudio metaanalítico se analizan todos los informes de evaluaciones de investigaciones sobre programas de capacitación en relaciones de parejas adultas financiados por la iniciativa de políticas de la ACF con el fin de estudiar su efecto en diversos resultados de bienestar en las parejas, las familias y las personas particulares. En general, en nuestro análisis de 32 estudios de grupos de referencia se hallaron distintos efectos pequeños pero significativos para la calidad de la relación de pareja (d = .114), las habilidades relacionales (d = .132), la salud mental (d = .074), y la cocrianza (d = .033), y efectos no significativos para la estabilidad relacional, la crianza y el bienestar de los niños. Los análisis complementarios con 19 estudios previos y posteriores de un grupo demostraron efectos más importantes. Sin embargo, los análisis planificados de moderadores analizaron la heterogeneidad significativa en la mayoría de los efectos y revelaron consecuencias interesantes para la práctica y la investigación en el futuro.

3.
Medwave ; 21(1): e8513, 2022 Jan 03.
Artículo en Español, Inglés | MEDLINE | ID: mdl-34979532

RESUMEN

This article summarizes the main elements, advantages, and disadvantages of Respondent-driven Sampling (RDS). Some criticisms regarding the feasibility of the inherent assumptions, their point estimators, and the obtained variances are pointed out. This article also comments on the problems observed in the quality of reports. Surveys using RDS should be methodologically sound as they are being applied to define priorities in health programs and develop national and international policies for financing service delivery, among other uses. However, there is considerable potential for bias related to implementation and analytical errors. There is limited empirical evidence on how representative the results obtained by RDS are, and the quest to improve the methodology is still in progress. Nevertheless, to have confidence in RDS results, we must verify that the social structure of the networks conforms to the assumptions required by the theory, that the sampling assumptions are reasonably fulfilled, and that the quality of the report is optimal, particularly for methodological and analytical items.


Este artículo resume algunas consideraciones, ventajas e inconvenientes de esta técnica de muestreo conocida como Respondent-driven Sampling (RDS). Se señalan algunas críticas que han aparecido en la literatura científica respecto a la viabilidad de los supuestos inherentes a esta técnica y, en consecuencia, respecto a los estimadores puntuales y de las varianzas así obtenidas. También, se comentan los problemas observados en la literatura acerca de la calidad de los reportes de este tipo de estudios. Las encuestas que utilizan RDS deben ser metodológicamente de buena calidad, pues están siendo aplicadas extensamente para definir prioridades de programas sanitarios, para desarrollar políticas nacionales e internacionales de financiamiento de prestación de servicios, entre otras aplicaciones. Sin embargo, existe un amplio potencial de sesgo al usar este método, muchos de los cuales están relacionados con la implementación y los errores analíticos. La evidencia empírica sobre cuán representativos son los resultados obtenidos mediante RDS es limitada, y la búsqueda para mejorar la metodología es un área de investigación aún en progreso. No obstante, para tener confianza en los resultados publicados debe verificarse que la estructura social de las redes estudiadas se ajusta a los supuestos requeridos por la teoría de RDS, que los supuestos del muestreo se cumplen razonablemente y que la calidad del reporte es óptima, en particular respecto a los ítems metodológicos y analíticos.


Asunto(s)
Infecciones por VIH , Sesgo , Humanos , Encuestas y Cuestionarios
4.
Lancet Public Health ; 7(1): e36-e47, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34995541

RESUMEN

BACKGROUND: The COVID-19 pandemic has affected sexual and reproductive health (SRH) service use and unmet need, but the impact is unknown. We aimed to determine the proportion of participants reporting sexual risk behaviours, SRH service use and unmet need, and to assess remote sexually transmitted infection (STI) testing service use after the first national lockdown in Britain. METHODS: We used data from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)-COVID cross-sectional, quasi-representative web survey (Natsal-COVID Wave 1). Adults aged 18-59 years who resided in England, Scotland, or Wales completed the survey between July 29 and Aug 10, 2020, which included questions about the approximate 4-month period after announcement of the initial lockdown in Britain (March 23, 2020). Quota-based sampling and weighting were used to achieve a quasi-representative population sample. Participants aged 45-59 years were excluded from services analysis due to low rates of SRH service use. Among individuals aged 18-44 years, we estimated reported SRH service use and inability to access, and calculated age-adjusted odds ratios (aORs) among sexually experienced individuals (those reporting any sexual partner in their lifetime) and sexually active individuals (those reporting any sexual partner in the past year). Unweighted denominators and weighted estimates are presented hereafter. FINDINGS: 6654 individuals had complete interviews and were included in the analysis. Among 3758 participants aged 18-44 years, 82·0% reported being sexually experienced, and 73·7% reported being sexually active. 20·8% of sexually experienced participants aged 18-44 years reported using SRH services in the 4-month period. Overall, 9·7% of 3108 participants (9·5% of men; 9·9% of women) reported being unable to use a service they needed, although of the participants who reported trying but not being able to use a SRH service at least once, 76·4% of participants also reported an instance of successful use. 5·9% of 1221 sexually active men and 3·6% of 1560 sexually active women reported use of STI-related services and 14·8% of 1728 sexually experienced women reported use of contraceptive services, with SRH service use highest among individuals aged 18-24 years. Sexually active participants reporting condomless sex with new partners since lockdown were much more likely to report using STI-related services than those who did not report condomless sex (aOR 23·8 [95% CI 11·6-48·9]) for men, 10·5 [3·9-28·2] for women) and, among men, were also more likely to have an unsuccessful attempt at STI-service use (aOR 13·3 [5·3-32·9]). Among 106 individuals who reported using STI testing services, 64·4% accessed services remotely (telephone, video, or online). Among 2581 women aged 25-59 years, 2·4% reported cervical screening compared with an estimated 6% in a comparable 4-month period before the pandemic. INTERPRETATION: Many people accessed SRH care during the initial lockdown; however, young people and those reporting sexual risk behaviours reported difficulties in accessing services and thus such services might need to address a backlog of need. FUNDING: Wellcome Trust, The Economic and Social Research Council, The National Institute for Health Research, Medical Research Council/Chief Scientist Office and Public Health Sciences Unit, and UCL Coronavirus Response Fund.


Asunto(s)
COVID-19 , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Conducta Sexual , Adulto , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Humanos , Entrevistas como Asunto , Masculino , Cuarentena , Enfermedades de Transmisión Sexual/prevención & control , Encuestas y Cuestionarios , Reino Unido , Neoplasias del Cuello Uterino/prevención & control , Adulto Joven
7.
BMC Infect Dis ; 22(Suppl 1): 51, 2022 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-35027000

RESUMEN

BACKGROUND: Several trials of community-based HIV self-testing (HIVST) provide evidence on the acceptability and feasibility of campaign-style distribution to reach first-time testers, men and adolescents. However, we do not know how many remain unaware of HIVST after distribution campaigns, and who these individuals are. Here we look at factors associated with never having heard of HIVST after community-based campaign-style HIVST distribution in rural Zimbabwe between September 2016 and July 2017. METHODS: Analysis of representative population-based trial survey data collected from 7146 individuals following community-based HIVST distribution to households was conducted. Factors associated with having never heard of HIVST were determined using multivariable mixed-effects logistic regression adjusted for clustered design. RESULTS: Among survey participants, 1308 (18.3%) self-reported having never heard of HIVST. Individuals who were between 20 and 60 years old {20-29 years: [aOR = 0.74, 95% CI (0.58-0.95)], 30-39 years: [aOR = 0.56, 95% CI (0.42-0.74)], 40-49 years: [aOR = 0.50, 95% CI (0.36-0.68)], 50-59 years [aOR = 0.58, 95% CI (0.42-0.82)]}, who had attained at least ordinary level education [aOR = 0.51, 95% CI (0.34-0.76)], and who had an HIV test before [aOR = 0.30, 95% CI (0.25-0.37)] were less likely to have never heard of HIVST compared with individuals who were between 16 and 19 years old, who had a lower educational level and who had never tested for HIV before, respectively. In addition, non-household heads or household head representatives [aOR = 1.21, 95% CI (1.01-1.45)] were more likely to report never having heard of HIVST compared to household head and representatives. CONCLUSIONS: Around one fifth of survey participants remain unaware of HIVST even after an intensive community-based door-to-door HIVST distribution. Of note, those least likely to have heard of self-testing were younger, less educated and less likely to have tested previously. Household heads appear to play an important role in granting or denying access to self-testing to other household members during door-to-door distribution. Differentiated distribution models are needed to ensure access to all. Trial registration PACTR, PACTR201607001701788. Registered 29 June 2016, https://pactr.samrc.ac.za/ PACTR201607001701788.


Asunto(s)
Infecciones por VIH , Autoevaluación , Adolescente , Adulto , Infecciones por VIH/diagnóstico , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven , Zimbabwe
8.
Br J Nurs ; 31(1): 8-14, 2022 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-35019744

RESUMEN

With the arrival of the COVID-19 pandemic, outpatient clinics had to adjust and reduce the number of face-to-face appointments. The Cambridge stoma service has a recognised pathway of stoma care but needed to adjust this in line with government guidelines. The team took the opportunity to audit the current pathway and complete a patient experience survey to determine the future of the service and potential adaptations to the pathway in the future. AIM: To determine the need for adaptation and improvement of the standard stoma clinics pathway. METHOD: A survey was conducted using a postal questionnaire to all patients who attended stoma clinics between April and June 2020. FINDINGS: 160 questionnaires were sent and 72 responses returned (45%). All elements of the virtual clinic were rated positive by more than 80% of respondents, with nearly 90% of them feeling that all their stoma care needs were met. When asked to indicate their preferred consultation methods (patients were allowed to choose more than one), face to face received 50 votes, telephone 32 votes and video clinic 5 votes. CONCLUSION: There is a need to adapt the standard clinic pathway to be able to offer standardised care but with flexibility to adjust to circumstances and patients' preferences.


Asunto(s)
COVID-19 , Pandemias , Vías Clínicas , Humanos , Evaluación del Resultado de la Atención al Paciente , SARS-CoV-2 , Encuestas y Cuestionarios , Teléfono
9.
JAMA ; 327(1): 41-49, 2022 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-34982119

RESUMEN

Importance: Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective: To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants: A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions: Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures: The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results: All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance: Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration: ClinicalTrials.gov Identifier: NCT02941614.


Asunto(s)
Neoplasias de la Mama/psicología , Servicios de Salud Comunitaria , Depresión/diagnóstico , Tamizaje Masivo , Derivación y Consulta/estadística & datos numéricos , Femenino , Humanos , Masculino , Oncología Médica , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Educación del Paciente como Asunto , Encuestas y Cuestionarios
11.
PLoS One ; 17(1): e0261509, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34990459

RESUMEN

The COVID Pandemic may affect fertility behaviour and intentions in many ways. Restrictions on service provision reduce access to family planning services and increase fertility in the short term. By contrast, the economic uncertainty brought about by the pandemic and its impact on mental health and well-being may reduce fertility. These various pathways have been explored in the context of high income countries such as the United States and Western Europe, but little is known about middle income countries. In this paper we asses the impact of the COVID pandemic on fertility intentions and behaviour in the Republic of Moldova, a middle income country in Eastern Europe, using the Generations and Gender Survey. This survey was conducted partially before and partially after the onset of the pandemic in 2020, allowing for detailed comparisons of individual circumstances. The results indicate that the pandemic reduced the used of intrauterine devices, and increased the use of male condoms, but with no overall decrease in contraceptive use. Conversely individuals interviewed after the onset of the pandemic were 34.5% less likely to be trying to conceive, although medium term fertility intentions were unchanged. Indicators therefore suggest that in the medium term fertility intentions may not be affected by the pandemic but restricted access to contraception requiring medical consultation and a decrease in short-term fertility intentions could disrupt short term family planning.


Asunto(s)
COVID-19/psicología , Fertilidad/fisiología , Conducta Reproductiva/psicología , Adulto , COVID-19/metabolismo , Condones/tendencias , Anticoncepción/tendencias , Conducta Anticonceptiva/tendencias , Composición Familiar , Servicios de Planificación Familiar/provisión & distribución , Servicios de Planificación Familiar/tendencias , Femenino , Humanos , Renta , Dispositivos Intrauterinos/tendencias , Masculino , Moldavia/epidemiología , SARS-CoV-2/patogenicidad , Encuestas y Cuestionarios
12.
Bull World Health Organ ; 100(1): 70-77, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35017759

RESUMEN

The food system and climate are closely interconnected. Although most research has focused on the need to adopt a plant-based diet to help mitigate climate change, there is also an urgent need to examine the effects of climate change on food systems to adapt to climate change. A systems approach can help identify the pathways through which climate influences food systems, thereby ensuring that programmes combating malnutrition take climate into account. Although little is known about how climate considerations are currently incorporated into nutrition programming, climate information services have the potential to help target the delivery of interventions for at-risk populations and reduce climate-related disruption during their implementation. To ensure climate services provide timely information relevant to nutrition programmes, it is important to fill gaps in our knowledge about the influence of climate variability on food supply chains. A proposed roadmap for developing climate-sensitive nutrition programmes recommends: (i) research aimed at achieving a better understanding of the pathways through which climate influences diet and nutrition, including any time lags; (ii) the identification of entry points for climate information into the decision-making process for nutrition programme delivery; and (iii) capacity-building and training programmes to better equip public health practitioners with the knowledge, confidence and motivation to incorporate climate resilience into nutrition programmes. With sustained investment in capacity-building, data collection and analysis, climate information services can be developed to provide the data, analyses and forecasts needed to ensure nutrition programmes target their interventions where and when they are most needed.


Les systèmes alimentaire et climatique sont étroitement liés. Bien que la plupart des recherches se concentrent sur le besoin d'adopter un régime végétarien pour contribuer à atténuer le changement climatique, il est également urgent d'examiner les effets de ce changement climatique sur les systèmes alimentaires afin de les adapter en conséquence. Une approche systémique peut aider à déterminer dans quelle mesure le climat influence les systèmes alimentaires, et dès lors à faire en sorte que les programmes de lutte contre la malnutrition en tiennent compte. On ignore encore sous quelle forme les considérations climatiques sont actuellement intégrées dans les programmes de nutrition. Cependant, les services climatologiques peuvent contribuer à cibler le déploiement d'interventions pour les populations à risque, ainsi qu'à réduire les perturbations causées par le climat au cours de leur mise en œuvre. Pour veiller à ce que ces services fournissent à point nommé des informations utiles aux programmes de nutrition, il faut impérativement combler le manque de connaissances en matière d'impact des variations climatiques sur les chaînes d'approvisionnement alimentaire. La feuille de route proposée pour l'élaboration de programmes de nutrition adaptés au changement climatique recommande: (i) de mener des recherches visant à mieux comprendre dans quelle mesure le climat influence l'alimentation et la nutrition, en tenant compte des éventuels décalages temporelshoraires; (ii) d'identifier les points d'entrée des informations relatives au climat dans le processus décisionnel de déploiement des programmes alimentaires; et enfin, (iii) de développer des plans de formation et de renforcement des capacités afin que les professionnels de la santé publique disposent des connaissances, de la confiance et de la motivation nécessaires pour intégrer l'adaptation au changement climatique dans les programmes de nutrition. En investissant durablement dans le renforcement des capacités ainsi que dans la collecte et l'analyse de données, il est possible d'instaurer des services climatologiques qui communiqueront les informations, analyses et prévisions requises pour que les programmes de nutrition organisent leurs actions à l'endroit et au moment où elles deviennent indispensables.


El sistema alimentario y el clima están muy interconectados. Aunque la mayoría de las investigaciones se han centrado en la necesidad de adoptar una dieta basada en el consumo de plantas para ayudar a mitigar el cambio climático, también es urgente analizar los efectos del cambio climático en los sistemas alimentarios para adaptarse al mismo. Un enfoque sistémico puede ayudar a identificar las vías a través de las que el clima influye en los sistemas alimentarios, garantizando así que los programas de lucha contra la malnutrición tengan en cuenta el clima. Si bien se sabe poco sobre cómo se incorporan en la actualidad los aspectos climáticos a los programas de nutrición, los servicios de información climática tienen el potencial de ayudar a orientar las intervenciones hacia las poblaciones de riesgo y a reducir los trastornos relacionados con el clima durante su aplicación. Para garantizar que los servicios climáticos proporcionen información oportuna y relevante a los programas de nutrición, es importante solucionar las carencias de nuestros conocimientos sobre la influencia de la variabilidad climática en las cadenas de suministro de alimentos. Una hoja de ruta propuesta para desarrollar programas de nutrición sensibles al clima recomienda i) la investigación destinada a lograr una mejor comprensión de las vías a través de las que el clima influye en la dieta y en la nutrición, incluidos los retrasos; ii) la identificación de los puntos de entrada de la información sobre el clima en el proceso de toma de decisiones para la ejecución de los programas de nutrición; y iii) los programas de creación de capacidad y formación para preparar mejor a los profesionales de la salud pública con los conocimientos, la confianza y la motivación que permitan incorporar la adaptación al clima en los programas de nutrición. Si se invierte de manera sostenida en la creación de capacidades, la recopilación y el análisis de datos, se pueden desarrollar servicios de información climática que proporcionen los datos, los análisis y las previsiones necesarios para garantizar que los programas de nutrición orienten sus intervenciones donde y cuando más se necesiten.


Asunto(s)
Desnutrición , Política Nutricional , Dieta , Abastecimiento de Alimentos , Humanos , Desnutrición/prevención & control , Estado Nutricional
13.
Rev Paul Pediatr ; 40: e2020494, 2022.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-35019010

RESUMEN

OBJECTIVE: To characterize the menstrual cycle (regularity and menstrual flow length), the prevalence of dysmenorrhea and self-monitoring of the cycle in students from Lisbon region, and explore the effect of chronological age, age at menarche and body mass index (BMI) on menstrual disorders. METHODS: This is a cross-sectional study with 848 girls aged 12-18 years. A questionnaire about the sociodemographic context and characteristics of the menstrual cycle, and weight and height measures were assessed. BMI was classified according to International Obesity Taskforce criteria. A descriptive analysis of the variables was made, and Odds Ratios (ORs) and 95% confidence intervals (95%CIs) were determined. RESULTS: Mean age at menarche was 12.4 years and mean BMI was 22.0kg/m2. Among adolescents, 59% have regular menstrual cycle, 83% have menstrual flow length of ≤6 days. 88% suffered from dysmenorrhea, among which 8,7% declare absenteeism from school and 49% took pain medication, and 65% self-monitor their menstrual cycle. Higher maternal education was associated with a higher self-monitoring of menstrual cycle among the sample (OR 1.60; 95%CI 1.15-2.17). Girls with menarche <12 years-of-age are more likely to have menstrual flow length of >6 days (OR 1.73; 95%CI 1.19-2.51) and dysmenorrhea (OR 1.87; 95%CI 1.11-3.16) than those with menarche ≥12 years-of-age. No significant association between BMI and menstrual cycle variables was observed. CONCLUSIONS: The results suggest that menstrual disorders are frequent and may be associated with early menarche, but not with BMI. It is important to encourage self-monitoring of the menstrual cycle to detect menstrual disorders timely and promote health and well-being.


Asunto(s)
Menarquia , Sobrepeso , Adolescente , Niño , Estudios Transversales , Femenino , Promoción de la Salud , Humanos , Ciclo Menstrual , Sobrepeso/epidemiología , Encuestas y Cuestionarios
14.
PLoS One ; 17(1): e0262325, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34986208

RESUMEN

BACKGROUND: COVID-19 has posed unique challenges for adolescents in different dimensions of their life including education, home and social life, mental and physical health. Whether the impact is positive or negative, its significance on the overall shaping of adolescents' lives cannot be overlooked. The aim of the present study was to explore impacts of the pandemic on the adolescents' everyday lives in Pakistan. METHODS: Following ethical approval, this cross-sectional study was conducted through September to December, 2020 via an online survey on 842 adolescents with the mean age of 17.14 ± SD 1.48. Socio-demographic data and Epidemic Pandemic Impact Inventory-Adolescent Adaptation (EPII-A) was used to assess the multi-dimensional effects of the pandemic. RESULTS: Among the 842 participants, 84% were girls. Education emerged as the most negatively affected Pandemic domain (41.6-64.3%). Most of the adolescents (62.0-65.8%) had reported changes in responsibilities at home including increased time spent in helping family members. Besides, increase in workload of participants and their parents was prominent (41.8% & 47.6%). Social activities were mostly halted for approximately half (41-51%) of the participants. Increased screen time, decreased physical activity and sedentary lifestyle were reported by 52.7%, 46.3% and 40.7% respectively. 22.2-62.4% of the adolescents had a direct experience with quarantine, while 15.7% experienced death of a close friend or relative. Positive changes in their lives were endorsed by 30.5-62.4% respondents. Being male and older adolescents had significant association with negative impact across most domains (p<0.05). CONCLUSIONS: Results have shown that COVID-19 exert significant multidimensional impacts on the physical, psycho-social, and home related domains of adolescents that are certainly more than what the previous researches has suggested.


Asunto(s)
COVID-19/epidemiología , COVID-19/psicología , Adolescente , Estudios Transversales , Educación , Familia , Femenino , Humanos , Masculino , Pakistán/epidemiología
15.
BMC Public Health ; 22(1): 13, 2022 01 05.
Artículo en Inglés | MEDLINE | ID: mdl-34986810

RESUMEN

BACKGROUND: Individual behavioural decisions are responses to a person's perceived social norms that could be shaped by both their physical and social environment. In the context of the COVID-19 pandemic, these environments correspond to epidemiological risk from contacts and the social construction of risk by communication within networks of friends. Understanding the circumstances under which the influence of these different social networks can promote the acceptance of non-pharmaceutical interventions and consequently the adoption of protective behaviours is critical for guiding useful, practical public health messaging. METHODS: We explore how information from both physical contact and social communication layers of a multiplex network can contribute to flattening the epidemic curve in a community. Connections in the physical contact layer represent opportunities for transmission, while connections in the communication layer represent social interactions through which individuals may gain information, e.g. messaging friends. RESULTS: We show that maintaining focus on awareness of risk among each individual's physical contacts promotes the greatest reduction in disease spread, but only when an individual is aware of the symptoms of a non-trivial proportion of their physical contacts (~ ≥ 20%). Information from the social communication layer without was less useful when these connections matched less well with physical contacts and contributed little in combination with accurate information from physical contacts. CONCLUSIONS: We conclude that maintaining social focus on local outbreak status will allow individuals to structure their perceived social norms appropriately and respond more rapidly when risk increases. Finding ways to relay accurate local information from trusted community leaders could improve mitigation even where more intrusive/costly strategies, such as contact-tracing, are not possible.


Asunto(s)
COVID-19 , Epidemias , Comunicación , Trazado de Contacto , Humanos , Pandemias , SARS-CoV-2
16.
BMC Palliat Care ; 21(1): 6, 2022 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-34991565

RESUMEN

BACKGROUND: Initiating discussion about death and dying is often considered a difficult topic for healthcare providers, thus there is a need for further research to understand this area, particularly in developing countries. The aim of this study was to describe preferences for the initiation of end-of-life care discussions in Indonesia, comparing the general population and health care professionals. METHODS: This cross-sectional, descriptive study analysed quantitative data from 368 respondents to an online questionnaire (255 general population (69%); 113 healthcare professionals (31%)) utilizing consecutive sampling and snowball sampling methods. RESULTS: Overall, most respondents (80%) stated that they would like to discuss end-of-life issues with a healthcare professional in the case of terminal illness. This was more marked amongst healthcare professionals compared with the general population (94% vs. 75%, respectively, p < 0,001). The preferred time for discussion was at first diagnosis (68% general population, 52% healthcare professionals, p = 0.017) and the preferred person to start the discussion was the doctor (59% general population, 71% healthcare professionals, p = 0.036). Fewer respondents wanted to know about prognosis compared to diagnosis (overall 76% v 93% respectively). CONCLUSION: Doctors have vital role in end-of-life care discussion, and attempts should be made to encourage physicians to initiate these conversations and respond to patient's requests when needed. These findings contribute to the existing body of knowledge in this area of practice, with focus on a developing country. The role of socio-cultural influences on these conversations warrants further research, in order to develop practical resources to support clinicians to appropriately conduct end-of-life care discussions with their patients and to provide data for policymakers to develop services.


Asunto(s)
Cuidados Paliativos al Final de la Vida , Cuidado Terminal , Estudios Transversales , Humanos , Indonesia , Investigación Cualitativa
17.
BMC Health Serv Res ; 22(1): 57, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35022052

RESUMEN

BACKGROUND: Large system transformation in health systems is designed to improve quality, outcomes and efficiency. Using empirical data from a longitudinal study of national policy-driven transformation of maternity services in England, we explore the utility of theory-based rules regarding 'what works' in large system transformation. METHODS: A longitudinal, qualitative case study was undertaken in a large diverse urban setting involving multiple hospital trusts, local authorities and other key stakeholders. Data was gathered using interviews, focus groups, non-participant observation, and a review of key documents in three phases between 2017 and 2019. The transcripts of the individual and focus group interviews were analysed thematically, using a combined inductive and deductive approach drawing on simple rules for large system transformation derived from evidence synthesis and the findings are reported in this paper. RESULTS: Alignment of transformation work with Best et al's rules for 'what works' in large system transformation varied. Interactions between the rules were identified, indicating that the drivers of large system transformation are interdependent. Key challenges included the pace and scale of change that national policy required, complexity of the existing context, a lack of statutory status for the new 'system' limiting system leaders' power and authority, and concurrent implementation of a new overarching system alongside multifaceted service change. CONCLUSIONS: Objectives and timescales of transformation policy and plans should be realistic, flexible, responsive to feedback, and account for context. Drivers of large system transformation appear to be interdependent and synergistic. Transformation is likely to be more challenging in recently established systems where the basis of authority is not yet clearly established.


Asunto(s)
Programas de Gobierno , Inglaterra , Femenino , Grupos Focales , Humanos , Estudios Longitudinales , Embarazo , Investigación Cualitativa
18.
BMC Bioinformatics ; 23(1): 2, 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34983369

RESUMEN

Cellular heterogeneity underlies cancer evolution and metastasis. Advances in single-cell technologies such as single-cell RNA sequencing and mass cytometry have enabled interrogation of cell type-specific expression profiles and abundance across heterogeneous cancer samples obtained from clinical trials and preclinical studies. However, challenges remain in determining sample sizes needed for ascertaining changes in cell type abundances in a controlled study. To address this statistical challenge, we have developed a new approach, named Sensei, to determine the number of samples and the number of cells that are required to ascertain such changes between two groups of samples in single-cell studies. Sensei expands the t-test and models the cell abundances using a beta-binomial distribution. We evaluate the mathematical accuracy of Sensei and provide practical guidelines on over 20 cell types in over 30 cancer types based on knowledge acquired from the cancer cell atlas (TCGA) and prior single-cell studies. We provide a web application to enable user-friendly study design via https://kchen-lab.github.io/sensei/table_beta.html .


Asunto(s)
Neoplasias , Programas Informáticos , Distribución Binomial , Humanos , Neoplasias/genética , Proyectos de Investigación , Tamaño de la Muestra
19.
BMC Health Serv Res ; 22(1): 33, 2022 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-34986862

RESUMEN

BACKGROUND: In January 2019, care pathways within specialist mental health and substance abuse treatment services were officially launched in Norway. The care pathway introduced timeframes for assessment and treatment, allowing a maximum of 6 weeks to finish assessment and provide the patient with a diagnosis, in addition to allowing a maximum of 6 weeks from diagnosis to the first evaluation. The different action points required coding. The system was based on goals to improve services by focusing on user participation, coordinated patient flow, avoidance of unnecessary waiting time, improvement of equal access to services regardless of geographic location, and increased emphasis on physical health and lifestyle. The purpose of our study was to examine how mental health professionals made sense of care pathways and furthermore, how issues of trust affected the process of implementation. METHODS: Our multiple case study included four outpatient clinics for adults in four community mental health centres (CMHCs) in different parts of Norway. Qualitative data were collected through in-depth individual and focus group interviews and analysed using systematic text condensation. The informants were treatment personnel and leaders in four different outpatient clinics for adults. RESULTS: The results indicated four distinct themes or reactions to the care pathway and its implementation: 1) lack of clarity regarding the overall goals and content of the care pathway; 2) the increased burden of coding, registration and administrative work, which professionals experienced as a stressor; 3) an IT and medical record system that did not correspond to the coding of the care pathway; and 4) an unrealistic distinction between assessment and treatment. These themes/reactions increased the health professionals' distrust towards the care pathway, and a process of sensemaking encouraged them to reduce the importance of the care pathway system and its implementation. CONCLUSION: Theories of trust help in understanding how mental health professionals interpret care pathway implementation. Distrust and resistance towards the care pathways overshadow some of the overall quality goals of the care pathway, a view that was indeed shared by mental health professionals.


Asunto(s)
Vías Clínicas , Servicios de Salud Mental , Adulto , Centros Comunitarios de Salud Mental , Personal de Salud , Humanos , Investigación Cualitativa , Confianza
20.
BMC Med Educ ; 22(1): 25, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35012542

RESUMEN

BACKGROUND INFORMATION: As part of an elective course, the Interdisciplinary Centre for Palliative Medicine at Duesseldorf University Hospital offers medical students the opportunity to personally meet and talk to a seriously ill patient on one or more occasions. The future physicians are provided with an opportunity to broaden their professional competence, i.e. their knowledge and skills in patient-centred communication at the end of life, and enhance their personal competence, for example in how to professionally handle their own emotions. A topical e-learning module helps the students to prepare for the meetings, and writing a reflection paper forms the basis for the concluding reflection seminar. OBJECTIVES: The study's objective is a global and outcome-based evaluation of the elective blended-learning course that provides real-world patient interaction. The outcome-based evaluation or outcome assessment aims to objectively evaluate changes identified in knowledge, skills and attitude among the participants of the elective-course. Furthermore, the evaluation aims to answer the question of whether changes especially in attitude (social skills and self-competence) should be expected after the students have met with severely ill or dying patients. METHOD: On two questionnaires specifically developed for this survey the students were able to provide a global rating of the elective course and describe their learning gains in palliative care. The students' learning gains were measured by means of 14 items reflecting the specific educational objectives of the offered elective course. Using the German school grading system as a rating scale, the students assessed their learning progress by retrospectively evaluating their skills before and after completion of the elective course (Comparative Self-Assessment, CSA). RESULTS: In the time from April 2018 till March 2020, 62 students participated in the evaluation. Overall, learning progress among students could be observed across all areas of competence, and in 50% of all retrospective self-assessment items the learning gains were ≥ 50%. The highest learning gain (63.6%) was observed in the students' ability to meet a severely ill patient without fear. The lowest learning gain was observed when students had to confront and accept their own mortality. CONCLUSIONS: The offered elective course supports students in achieving social and self-competence development goals. According to the obtained results, contact with real-world patients helps mould the students' attitude.


Asunto(s)
Educación de Pregrado en Medicina , Estudiantes de Medicina , Competencia Clínica , Comunicación , Curriculum , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos
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